Sutherlandia frutescens

Health Care Professional Information

Scientific Name
Sutherlandia frutescens, Lessertia frutescens
Clinical Summary

Sutherlandia frutescens is a shrub native to South Africa and the coast of West Africa. This plant and its related species have been used by the locals as medicine to treat diabetes, chicken pox, and external wounds. Although Sutherlandia is not generally consumed as a dietary supplement in the West, some use the raw herb as an adaptogen. Constituents in Sutherlandia have antiviral, antibacterial, antifungal and anticancer properties (2). Sutherlandia is also known as Cancer bush for its purported use as a cancer treatment. There are case reports of Sutherlandia's ability to reduce fatigue in cancer patients (3).

In recent years, there has been a growing effort in Africa to promote the use of local herbs to treat AIDS due to the lack of availability of pharmaceuticals. Based on reports that Sutherlandia is effective against HIV virus (4), it has been proposed as a treatment for AIDS (5). The safety and efficacy of this herb have been studied in HIV-infected adults. The data are yet to be published (6).
Adverse effects are rare but Sutherlandia has been shown to inhibit P-glycoprotein and cytochrome P450 3A4 and can interact with other substrate drugs, particularly those used to treat AIDS (7) (8).

Food Sources
  • Sutherlandia frutescens is generally consumed as a tea.
Purported Uses
  • Prevent infection
  • As tonic
  • Stomach and blood ailments
  • Cancer
  • AIDS
Constituents
  • L-canavanine
  • L-arginine
  • Pinitol
  • Gamma amino butyric acid (GABA)
  • Triterpenoid Glucoside
    (2)
Mechanism of Action

Sutherlandia was shown to have antioxidant and anti-inflammatory effects in vitro (9).
Pinitol, a constituent of Sutherlandia, demonstrated antidiabetic effects by increasing the availability of glucose for cell metabolism (2). Sutherlandia was also shown to upregulate VAMP3, a gene which plays a role in vesicle transport, and also regulate 26 other genes that code for vesicle transporters, receptors, signalling molecules, transcription factors, and metabolic enzymes (14).
GABA found in the dry leaves of this herb can slow down nerve cell activity (2).
In other studies, the ethanolic extract of Sutherlandia inhibited growth of MCF-7 breast adenocarcinoma cell line by inducing apoptosis (10) (11). Sutherlandia also downregulated metalloproteinases (MMP), which control cell migration, proliferation, apoptosis, and regulate tumor expansion, angiogenesis and dissemination (10).

Contraindications
  • Pregnant women should not take Sutherlandia frutescens.
Adverse Reactions

Common: Diarrhea, dry mouth, dizziness.
Rare: Drinking or swallowing high doses of Sutherlandia may cause sweating and vomiting
(2)

Herb-Drug Interactions
  • Cytochrome P450 substrates: Sutherlandia inhibits CYP3A4 and can affect the intracellular concentration of drugs including antiretroviral treatments metabolized by these enzymes (7). But in a study of rats, it was shown to induce rat CYP3A2/human equivalent CYP3A4, resulting in decrease in intracellular concentration of nevirapine, a a non-nucleoside reverse transcriptase inhibitor (16).
  • P-Glycoprotein substrates: Sutherlandia was shown to inhibit P-Gp activity and can interfere with the metabolism of drugs including antiretroviral treatments (8).
  • Atazanavir: Sutherlandia was shown to significantly reduce the bioavailability of Atazanavir, an antiretroviral protease inhibitor (17).
Literature Summary and Critique

Johnson Q, Syce J, Nell H, et al. A randomized, double-blind, placebo-controlled trial of Lessertia frutescens in healthy adults. PLoS Clin Trials. 2007;2(4):e16.
This is the first clinical trial of Sutherlandia conducted to determine its toxicity and hemotological effects. Twenty-five healthy adults were randomized to consume either Sutherlandia leaf powder 800mg daily or a placebo. After 3 months, the Sutherlandia group reported better appetite. No other clinically significant differences were found between the two groups.
Further studies are needed to determine the efficacy of Sutherlandia products.

Dosage (Inside MSKCC Only)
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References
  1. Sutherlandia. http://www.sutherlandia.org/literature.html. Accessed April 18, 2014.
  2. van Wyk BE, Albrecht C. A review of the taxonomy, ethnobotany, chemistry and pharmacology of Sutherlandia frutescens (Fabaceae).J Ethnopharmacol. Oct 28 2008;119(3):620-629.
  3. Grandi M RL, Vernay M. Lessertia (Sutherlandia frutescens) and fatigue during cancer treatment. Phytotherapie. 2005;3:110.
  4. Harnett SM, Oosthuizen V, van de Venter M. Anti-HIV activities of organic and aqueous extracts of Sutherlandia frutescens and Lobostemon trigonus. J Ethnopharmacol. Jan 4 2005;96(1-2):113-119.
  5. Morris K. Treating HIV in South Africa—a tale of two systems. Lancet. Apr 14 2001;357(9263):1190.
  6. A Controlled Study of the Safety and Efficacy of Lessertia Frutescens in HIV-infected South African Adults.
    http://www.clinicaltrials.gov/ct2/show/NCT00549523?term=sutherlandia&rank=2. Accessed April 18, 2014.
  7. Mills E, Foster BC, van Heeswijk R, et al. Impact of African herbal medicines on antiretroviral metabolism. AIDS. Jan 3 2005;19(1):95-97.
  8. Brown L, Heyneke O, Brown D, van Wyk JP, Hamman JH. Impact of traditional medicinal plant extracts on antiretroviral drug absorption. J Ethnopharmacol. Oct 28 2008;119(3):588-592.
  9. Fernandes AC, Cromarty AD, Albrecht C, van Rensburg CE. The antioxidant potential of Sutherlandia frutescens. J Ethnopharmacol. Nov 2004;95(1):1-5.
  10. Stander BA, Marais S, Steynberg TJ, et al. Influence of Sutherlandia frutescens extracts on cell numbers, morphology and gene expression in MCF-7 cells. J Ethnopharmacol. Jun 13 2007;112(2):312-318.
  11. Stander A, Marais S, Stivaktas V, et al. In vitro effects of Sutherlandia frutescens water extracts on cell numbers, morphology, cell cycle progression and cell death in a tumorigenic and a non-tumorigenic epithelial breast cell line. J Ethnopharmacol. Jul 6 2009;124(1):45-60.
  12. Chinkwo KA. Sutherlandia frutescens extracts can induce apoptosis in cultured carcinoma cells. J Ethnopharmacol. Apr 8 2005;98(1-2):163-170.
  13. Johnson Q, Syce J, Nell H, Rudeen K, Folk WR. A randomized, double-blind, placebo-controlled trial of Lessertia frutescens in healthy adults. PLoS Clin Trials. 2007;2(4):e16.
  14. Williams S, Roux S, Koekemoer T, van de Venter M, Dealtry G. Sutherlandia frutescens prevents changes in diabetes-related gene expression in a fructose-induced insulin resistant cell model. J Ethnopharmacol. 2013 Mar 27;146(2):482-9.
  15. Minocha M, Mandava NK, Kwatra D, Pal D, Folk WR, Earla R, Mitra AK. Effect of short term and chronic administration of Sutherlandia frutescens on pharmacokinetics of nevirapine in rats. Int J Pharm. 2011 Jul 15;413(1-2):44-50.
  16. Müller AC, Skinner MF, Kanfer I.Effect of the African Traditional Medicine, Sutherlandia frutescens, on the Bioavailability of the Antiretroviral Protease Inhibitor, Atazanavir. Evid Based Complement Alternat Med.2013;2013:324618.

Consumer Information

How It Works

Bottom line: Laboratory studies indicate anticancer effects of Sutherlandia frutescens, but it has not been shown to treat or prevent cancer in humans.

Sutherlandia frutescens is a shrub native to Southern Africa and along the coast of West Africa. It is used in traditional medicine to treat diabetes, chicken pox, and external wounds, and also as a cancer treatment. Laboratory studies show that Sutherlandia can fight off viruses, bacteria, fungi, and also has anticancer properties. A few case reports show that it can decrease fatigue in cancer patients.
Because Sutherlandia can fight HIV virus, it is being proposed as an AIDS treatment in Africa. Clinical trials are needed to determine Sutherlandia's safety and efficacy.

Purported Uses
  • Prevent infections
    Laboratory studies show that Sutherlandia has antibacterial, antiviral, and antifungal effects. Human studies are needed.
  • Stomach and blood ailments
    There is no scientific evidence to support this claim.
  • Cancer
    Sutherlandia showed anticancer effects in lab studies, but it has not been studied in cancer patients.
  • AIDS
    Laboratory studies indicate that Sutherlandia has antiviral properties. Data from a clinical study are yet to be published.
Do Not Take If
  • You are pregnant.
  • You are taking drugs that are substrates of Cytochrome P450 3A4 (Sutherlandia may increase the risk of side effects of these drugs).
  • You are taking drugs that are substrates of P-Glycoprotein (Sutherlandia may increase the risk of side effects of these drugs).
Side Effects

Common: Diarrhea, dry mouth, dizziness.
Rare: Drinking or swallowing high doses of Sutherlandia may cause sweating and vomiting.

E-mail your questions and comments to aboutherbs@mskcc.org.